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Biomedical subjects

C Bouchet

Publications and source records attributed to C Bouchet.

At least 19 recordsLinked to original sources
PubMed2000

Parenteral with enteral nutrition in the critically ill.

OBJECTIVE: To determine whether nutrient intake by early enteral nutrition with parenteral nutrition improves levels of retinol-binding protein and prealbumin (primary endpoint) and reduce morbidity and mortality (secondary endpoint) in ICU patients. DESIGN: Prospective, double-blind, and randomized, placebo-controlled study. SETTING: Two intensive care units in a tertiary institution. PATIENTS AND PARTICIPANTS: 120 patients in two groups of 60. INTERVENTIONS: Patients received either enteral plus parenteral nutrition (treatment group) or enteral nutrition plus placebo (placebo group) for 4-7 days after initiation of nutritional support. MEASUREMENTS AND RESULTS: Retinol-binding protein (P = 0.0496) and prealbumin (P = 0.0369) increased significantly in the treatment group from day 0 to day 7. There was no reduction in morbidity in ICU. There was no difference in OMEGA score (263 vs. 244) and length of stay in the ICU (16.9 vs. 17.3), but a reduction in length of stay at hospital (31.2+/-18.5 vs. 33.7+/-27.7, P = 0.0022). Mortality on day 90 (17 vs. 18) and after 2 years (24 vs. 24) was identical. CONCLUSIONS: Although it enhances nutrient intake and corrects nutritional parameters such as RBP and prealbumin more rapidly, within 1 week, supplemental parenteral nutrition has no clinically relevant effect on outcome in ICU patients at the early phase of nutritional support.

Analysis of Variance↗
PubMed2000

Selection of quality-of-life measures for a prevention trial: a psychometric analysis.

Quality-of-life (QoL) outcomes have become increasingly important in the evaluation of health interventions. The objective of the present study was to determine which of three generic QoL instruments was most suitable for use in an 8-year nutritional primary prevention trial. We compared the Duke Health Profile, the Nottingham Health Profile, and the Short Form Health Survey Questionnaire (SF36). We conducted the comparison in two stages: (1) a statistical analysis of data from a pilot study (n = 963) comparing the psychometric properties of the three instruments; and (2) an assessment of the practicality of the tools. With regard to psychometric properties, convergent validity was comparable for the three scales, and the correlation with Global Health Assessment ranged from 0.24 to 0.72. Discriminant validity was best for the SF36, with a difference between scores in healthy subjects and those with chronic disease in the range of 4.4 to 15.8 (scores could range from 0 to 100, where 100 indicates perfect health). Reproducibility was good for all three instruments, with a test-retest intraclass correlation coefficient of over 0.60 for most dimensions. DHP and SF36 performed best in terms of responsiveness. We judged the practicality of the three tools as satisfactory. We chose the SF36 for its high responsiveness. We also selected the Duke Health Profile for its practicality and favorable psychometric properties.

Cardiovascular Diseases↗
PubMed2000

[Breast cancer: prognostic value of a dissemination index based on 4 components of the urokinase-type plasminogen activator system].

Among the proteases involved in the tumor invasion process, components of the plasminogen activator system (plasminogen activator type-urokinase uPA, its membrane receptor uPAR and its two inhibitors PAI-1 and PAI-2) appear to define high risk patients in primary breast cancer. As individual analysis of each component of the plasminogen activator system does not reflect the complex interactions between the different components, we studied the prognostic impact of a dissemination risk index combining the four variables. We found that this index was the most powerful prognostic factor, particularly in node-negative patients.

Adult↗
PubMed2000

Relationship between c-erbB-2 and other tumor characteristics in breast cancer prognosis.

The aim of this study was to evaluate c-erbB-2 overexpression by means of a quantitative biochemical technique in 488 primary breast cancer patients with long-term follow-up (median, 10 years) and its relation to other biochemical prognostic factors (uPA, p53, and epidermal growth factor receptor) and adjuvant therapy. High levels of c-erbB-2 (>500 IU/mg protein) were associated with estrogen receptor (ER) and progesterone receptor negativity, high histoprognostic SBR grade and high levels of uPA and p53. Univariate analyses showed shorter metastasis-free survival (MFS) and overall survival (OS) in patients whose tumors overexpressed c-erbB-2 in the overall population, in subgroups defined by ER and uPA status, and in patients with positive pathological nodal status, SBR grade II, progesterone receptor, and p53-negative tumors. Patients with ER-positive, c-erbB-2-positive tumors had a shorter MFS and OS than those patients with c-erbB-2-negative tumors. No difference was observed between adjuvant-treated and untreated patients (chemotherapy and/or hormone therapy) in the c-erbB-2-negative subgroup. There was a trend toward a longer short-term MFS in c-erbB-2-positive patients treated with chemotherapy, whereas an opposite effect was observed with hormone therapy. Cox multivariate analyses showed that high levels of c-erbB-2 negatively influenced MFS in the overall population as well as in node-positive patients and in tamoxifen-treated patients, along with pN and uPA. Results for OS were comparable with those obtained for MFS. These results suggest that c-erbB-2 overexpression in breast cancer may be a better predictor of the response to tamoxifen than is ER status alone.

Adult↗
PubMed1999

Dissemination risk index based on plasminogen activator system components in primary breast cancer.

PURPOSE: To study interactions between disease-free survival (DFS) and four components of the plasminogen activator system: urokinase-type plasminogen activator (uPA), its two inhibitors (PAI-1 and PAI-2), and its membrane receptor uPAR. PATIENTS AND METHODS: We conducted a retrospective study of 499 primary breast cancer patients (median follow-up, 6 years). uPA, PAI-1, and PAI-2 were determined on cytosols and uPAR on solubilized pellets, using enzyme-linked immunoadsorbent assay kits (American Diagnostica, Greenwich, CT). Classical univariate and multivariate statistical methods were used together with multiple correspondence analysis to graphically examine interactions between the variables and outcome. RESULTS: By univariate analysis, higher uPA and PAI-1 values were significantly related to shorter DFS (P =.002; P <.00002). PAI-2 was not significantly related to DFS, although patients with high and very low PAI-2 values had a longer DFS. Multiple correspondence analysis showed the parallel impact of uPA and PAI-1 on outcome, and the clearly different behavior of PAI-2 compared with PAI-1. The prognostic contribution of uPAR seemed weak by both methods. A dissemination risk index [uPA x PAI-1/(PAI-2 + 1)], taking into account the modulation of uPA proteolytic activity by the ratio of its two inhibitors, was then tested. Dissemination risk index was selected as an independent variable in the Cox model in the overall population (P <.000001) and in node-positive patients (P <.00001). It was the only variable selected in node-negative patients (P =. 003). CONCLUSION: A dissemination risk index determined on primary tumor and taking into account the different effects of PAI-1 and PAI-2 on uPA can be of major help in clinical management of breast cancer, particularly in node-negative patients.

Adult↗
PubMed1998

Prognostic value of urokinase plasminogen activator in primary breast carcinoma: comparison of two immunoassay methods.

Urokinase-type plasminogen activator (uPA) is a potentially important prognostic factor in breast cancer for identifying patients at high risk of recurrence. This retrospective study assessed two enzyme-linked immunosorbent assay (ELISA) methods measuring uPA antigen levels in 499 primary breast cancer cytosols. Both uPA methods were applied to cytosols used routinely for oestrogen (ER) and progesterone (PgR) receptor assays. uPA was determined using a classical ELISA method (Imubind; American Diagnostica) and a novel automatic immunoluminometric assay (Lia; Sangtec Medical). The uPA Imubind method revealed about twice as much uPA antigen (median 0.75 ng mg(-1) protein) as the uPA Lia method (median 0.38 ng mg(-1) protein). The correlation coefficient between the two methods was acceptable (r = 0.81), but the two techniques are not interchangeable. Univariate analyses confirmed the poor outcome of patients whose tumours contained large amounts of uPA, regardless of the technique used. Multivariate analyses showed that uPA Imubind and uPA Lia values were both strong independent prognostic factors.

Adult↗
PubMed1998

Integration of the analytical and alphabetical ICD10 in a coding help system. Proposal of a theoretical model for the ICD representation.

UNLABELLED: In French hospitals, medical diagnosis coding with the ICD10 is commonly performed and the use of effective tools would help coders in their task. AIM OF THIS WORK: To ameliorate an existing coding help system. This system, which already consists of the ICD10 analytical index, would be increased with the terms of the alphabetical index that includes lexical variants and additional terms as well. The addition of the second volume of the ICD would allow the coding of more terms and would lessen documentary silence. METHODS: The first step of this work was a careful study of a theoretical model of the ICD content. Then the alphabetical index file was submitted to a lexical analysis, and it was automatically transformed to be integrated into the existing coding help system. RESULTS: Compromise had to be made between a theoretical model and between what could be obtained in practice by an automatic processing of the file. Finally the alphabetical index was added to the initial thesaurus, which represents 42,000 terms and 4,000 additional words. Links between words and codes were also considerably increased, which has enhanced the searching possibilities of the tool and lessen documentary silence. Conversely the research time has been increased. CONCLUSION: Difficulties have to be encountered when trying to turn a manual tool into an automatic research tool.

Abstracting and Indexing↗
PubMed1998

Differences of case-mix according to the type of hospital: methodological aspects and results.

This study has brought to the fore variations of case-mix according to the type of French hospitals taken into consideration. The GHM line-up in the French classification of the hospital stays (French DRG) have also been studied and variations linked to the type of hospitals have been noticed too. This survey has been carried out thanks to the anonymous discharge summary issued by the national and the regional databases.

Diagnosis-Related Groups↗
PubMed1998

Evaluating a computerized tool for coding patient information.

OBJECTIVE: Computerized tools may be useful in speeding up and facilitating the laborious task of coding patient information. This paper describes a method of objectively evaluating their efficiency. DESIGN: 38 study subjects were randomly assigned to a manual coding group or an automated coding group, with stratification according to two variables (used to coding yes/no, physician yes/no). Subjects then coded the same standardized set of diagnoses in a limited time. The numbers of exact codes retrieved were compared using a global analysis of variance model. RESULTS: The two groups were not significantly different with regard to the number of physicians (p = 0.74) and the number of usual coders (p = 0.52) they included. Significantly more exact codes were achieved in the group using automated coding than among the manual group (p = 0.04). Physicians were significantly more efficient at coding than non-physicians (p = 0.02). CONCLUSION: This study describes an objective means of evaluating the performance of an automated coding tool. It shows that better results were achieved with the computerised compared to the manual method, even when the superior abilities of physicians were taken into account.

Disease↗
PubMed1997

[The DUKE health profile: a generic instrument to measure the quality of life tied to health].

To adapt the DUKE Health Profile, a 17-item self-report generic health related quality of life measure cross-culturally in french. A multidisciplinary expert committee was provided with three translations independent of each other, each backtranslated to the original language, and produced a synthesis version equivalent to the original. A cohort of 963 persons from the general population filled in the questionnaire twice in three months. The internal consistency was acceptable (Cronbach's alpha = 0.63-0.81) except in social dimension. Convergent validity was evidenced by a significant correlation with overall health. The test-retest reproducibility in stable subjects (601) was satisfactory (intraclass coefficient correlation r = 0.63-0.78) except in pain and disability dimensions. There was a significant modification of scores in the same direction as overall health change in subjects improved (n = 128) or worsened (n = 187). Age-adjusted scores were lower in females, in subjects with lower education, urban residency, unemployed and living alone and in subjects reporting a chronic disease. This short form questionnaire similar to the original version proved simple to use in the general population.

Health Status↗
PubMed1996

Nonspecific effects in longitudinal studies: impact on quality of life measures.

A variety of factors may influence outcome measures in longitudinal studies, including placebo, Hawthorne, or natural history effects. Quality of life (QoL) measures are particularly subject to these phenomena. This 2-month postal survey was set up to examine the extent of nonspecific effects in a treatment (vitamin supplementation) group (n = 180), a placebo group (n = 180), as part of a stratified, randomized controlled trial, and two control groups (n = 768 each). Quality of life was measured using the SF36. The placebo effect had a significant impact on improving physical, mental, and pain dimensions (p = 0.02 to 0.04), and the Hawthorne effect was significant (p = 0.03 to 0.009) for psychological dimensions. Although the impact of natural history was not significant, it tended to worsen all QoL dimensions. Vitamin supplementation had no effect on QoL. These results demonstrate the importance of placebo and Hawthorne effects and suggest that they may be responsible for misleading results or reductions in the power of controlled trials.

Adult↗
PubMed1996

[Validation of the St George's questionnaire for measuring the quality of life in patients with chronic obstructive pulmonary disease].

The validity of a French version of a disease specific quality of life instrument, the St George's Respiratory Questionnaire, has been assessed in a sample of 64 patients with chronic respiratory disease undergoing oxygen therapy. The studied properties were internal consistency, test-retest reproducibility and criterion validity. The St George's showed a good internal consistency with Cronbach's alpha coefficients from 0.61 to 0.95 and a good reproducibility with Intraclass Correlation Coefficients (ICC) from 0.67 to 0.95. High correlation with dyspnea (p=0.0004 to 0.01) showed a correct criterion validity. So psychometric properties of the French version of the questionnaire are good. However, its administration caused a few problems, and we advice it to be administered by a trained interviewer in such patients.

Activities of Daily Living↗
PubMed1995

[Comparison of 3 quality of life instruments in the longitudinal study of rheumatoid arthritis].

Quality of life measures take into account the patient's perception of health. Many generic or specific instruments are available. The psychometric properties of such measures should allow for adequately testing the hypothesis of an investigation. We studied the properties of three quality of life measures: the Health Assessment Questionnaire (HAQ) specific for rheumatic diseases, the Nottingham Health Profile (NHP)--a generic measure--and the General Health Questionnaire (GHQ) which measures psychological dimensions. They were applied in a one year cohort study of 111 French rheumatoid arthritis patients set up for determining prognosis factors of quality of life. Criterion validity was established on high correlation between Ritchie index and physical dimensions (r = 0.29 to 0.58, p < 0.01). Internal consistency was good with Cronbach's alpha coefficients over 0.8 for all dimensions. Reproducibility was studied for physical dimensions with Intra-class Correlation Coefficient (ICC) for patients clinically unchanged. It was excellent for the HAQ (ICC = 0.89), good for the NHP (ICC = 0.57 to 0.73) but weak for the GHQ (ICC = 0.13 for somatic dimension). After one year follow-up, a significant change in quality of life could only be evidenced by the HAQ (Standardized Response Mean = 0.4, p < 0.05) in patients with clinical significant change. So among the three instruments, the HAQ should be preferred for longitudinal studies, possibly supplemented with a generic instrument that investigates more dimensions of quality of life.

Adult↗
PubMed1995

Comparative study of four extraction procedures for urokinase type plasminogen activator and plasminogen activator inhibitor-1 in breast cancer tissues.

The urokinase type plasminogen activator (u-PA) and the plasminogen activator inhibitor-1 (PAI-1) are among the best second-generation prognostic tissue factors in breast cancer. However, different extraction procedures and assay kits are used in different laboratories. A total of 79 breast tumour tissues stored in liquid nitrogen were analysed in this study. We compared u-PA and PAI-1 levels determined with the American Diagnostics (AD) kit after various extraction procedures. The median cytosolic extraction yield in the presence of 0.4 mol/l KCl, calculated relative to extraction in the presence of 10 ml/l Triton X100 when adapted to standard laboratory working hours (incubation for 2 h instead of 12 h) was 74.4% for u-PA and 85.8% for PAI-1. In addition, the correlations were acceptable. Cytosolic extracts prepared with KCl could permit optimal u-PA and PAI-1 assays while also enabling hormone receptors to be determined with the same specimens. Further studies with clinical data are now necessary to determine the prognostic relevance of this extraction procedure.

Breast Neoplasms↗
PubMed1994

Prognostic value of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitors PAI-1 and PAI-2 in breast carcinomas.

It is now clearly established that proteolytic enzymes, including plasminogen activator (uPA), play an important role in breaking down the extracellular matrix, which is considered to be a step in metastasis formation. Plasminogen activators are controlled at various levels. Two inhibitors, PAI-1 and PAI-2, have been identified, the latter being more specific for uPA. In attempts to determine their prognostic value, it is essential to investigate the relative importance of these parameters and their interactions. We used an immunoenzymatic method to assay uPA, PAI-1 and PAI-2 antigens in cytosols prepared from 314 primary breast tumours. The patients were followed up for a minimum of 6 years and all relevant clinical and laboratory findings were recorded. Univariate analysis confirmed the poor outcome of patients whose tumours contained large amounts of uPA and PAI-1. In addition, low levels of PAI-2 correlated with shorter disease-free survival in the overall population (P = 0.02), post-menopausal women (P = 0.02) and women without lymph node involvement (P = 0.02). Multivariate analysis in the 'main effects' Cox model identified node involvement, macroscopic tumour size and PAI-2 as significant variables. The 'interactive' model, taking into account interactions between uPA and its two inhibitors, identified a first subgroup with a very poor prognosis associating either high levels of PAI-1 with low levels of PAI-2 in the overall population and the women with no node involvement or high levels of uPA with low levels of PAI-2 in the group of menopausal women. We conclude that PAI-1 provides the same prognostic information as uPA, and does not appear to play a role as an inhibitor. In contrast, PAI-2 increases the prognostic value of uPA, particularly in post-menopausal women, and PAI-1 in patients with no node involvement.

Adult↗
PubMed1994

[Prognostic value of urokinase-type plasminogen activator and 2 inhibitors PAI-1 and PAI-2 in breast cancer].

It is now clearly established that proteolytic enzymes, and in particular plasminogen activator (uPA), play an important role in breaking down the extracellular matrix, which is considered to be a step in metastasis formation. Plasminogen activators are controlled at various levels. Two inhibitors, PAI-1 and PAI-2, have been identified, the latter being more specific for uPA. In attempts to determine their prognostic value, it is essential to investigate the relative importance of these parameters and their interactions. We used an immunoenzymatic method to assay uPA, PAI-1 and PAI-2 antigens in cytosols prepared from 314 primary breast tumors. The patients were followed up for a minimum of six years and all relevant clinical and laboratory findings had been recorded. Univariate analysis confirmed the poor outcome of patients whose tumors contained large amounts of uPA and PAI-1. In addition, low levels of PAI-2 correlated with shorter disease-free survival in the overall population (P = 0.02), post-menopausal women (P = 0.02) and women without lymph node involvement (P = 0.02). Multivariate analysis using the "Main Effects" Cox model identified node involvement, macroscopic tumor size and PAI-2 as significant variables. The "interactive" Cox model, taking into account interactions between uPA and its two inhibitors, identified a first subgroup with a very poor prognosis associating either high levels of PAI-1 with low levels of PAI-2 in the overall population as well as following stratification for axillary node negative disease, or high levels of uPA with low levels of PAI-2 in the group of menopausal women. We conclude that PAI-1 provides the same prognostic informations as uPA, and does not appear to play its role as an inhibitor. In contrast, PAI-2 increased the prognostic value of both uPA, particularly in post-menopausal women, as well as PAI-1 in a subgroup of axillary node negative patients.

Adult↗